Background The development of a hernia is a known complication of peritoneal dialysis (PD), and such patients have high rates of hernia surgery. This study evaluated the association between hernia surgery and the primary outcome of transfer to haemodialysis (HD) for >90 days. Methods The study included all patients who started PD in Australia and New Zealand between 2000 and 2015. Using bi-national data linkage between the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets, patients receiving PD who underwent hernia surgery, based on Australian Classification of Health Interventions (ACHI) coding were matched in a 1:3 ratio with those who did not undergo hernia surgery (controls), using propensity score matching based on year of PD start, age, body mass index (BMI), ischaemic heart disease (IHD) and diabetes mellitus (DM). The surgery date for cases was used as a mock index date for potential controls who were alive and at risk at that time, to minimise immortal time bias. Time from surgery or mock index date to HD transfer was analysed by Cox regression with shared frailty to account for centre effect, censored for kidney transplantation, death or end of study (31 December 2021). Results A total 1,433 PD patients underwent hernia surgery. The characteristics of the matched controls when compared to cases were similar in age, PD vintage, BMI, and rates of IHD and DM, however differed in gender proportions (70% male in cases vs. 66% in controls). Cox regression showed that hernia surgery had an increased risk of HD transfer over entire follow up (HR 1.22, 95% CI 1.12 – 1.34). Male gender, vintage, larger BMI and DM were also associated with increased HD transfer risk. Conclusion In patients receiving PD, patients who underwent hernia surgery had increased risk the primary outcome of HD transfer for >90 days compared to patients receiving PD who did not undergo surgery.